Registration

Middleton Lads & Girls FC Annual Subs Payment

Team Options

Age: U7-U18

Colour: Blue, Red, Black, White, Green or Purple

Customer Ref:

Schedule

Service/Schedule:

Termination:

Until further notice

Payment Information

Payment Day:

2025

First Payment Date:

15 July 2025

I wish to pay a regular Direct Debit of:

£200.00

Personal Details

Title

First name

Surname

Line1

Line2

Line3

Line4

Post code

Home phone number

Mobile phone number

Work phone number

Additional Information


1. Player 1's Name: *
2. Player 1's Team (Age and Colour): *
3. Player 1's Manager's Name: *
4. Player 2's Name: *
5. Player 2's Team (Age and Colour): *
6. Player 2's Manager's Name: *
7. Player 3's Name: *
8. Player 3's Team (Age and Colour): *
9. Player 3's Manager's Name: *

Instruction to your Bank or Building Society to pay by Direct Debit

APS Re RUG DOCTOR LIMITED, 81 Hereford Way, Middleton, M24 2NN

Service User Number:

Account holder name

Account number

Bank sort code

Please tick to confirm you are the only person required to sign for this account

Checking the box indicates that I am the Bank/Building Society holder and no authority other than my own is required. If more than one person is required to authorise debits from the account, you are unable to setup a direct debit online.